How the “One Big Beautiful Bill” Impacts End-of-Life Care—and What You Should Do Now
If you’re worried about the rising cost of care for yourself or a loved one, you're not alone.
At Genera, we help families navigate the complex—and often devastating—world of long-term care, Medicaid planning, and end-of-life decisions. And now, with the passage of the new federal One Big Beautiful Bill (OBBB), many of the rules are about to change. But one thing hasn’t: if you wait too long to plan, your family will still pay the price.
This post breaks down exactly what the new law means for you, your aging parents, and anyone concerned about preserving dignity, protecting assets, and avoiding chaos at the end of life.
Why This Matters
End-of-life care in America is cripplingly expensive. More than 50% of Americans over 65 will need long-term care, yet most people are shocked to learn that Medicare doesn’t cover nursing homes or full-time in-home care. That’s where Medicaid steps in—but only after you’ve drained most of your life savings.
The One Big Beautiful Bill (OBBB), passed July 3, 2025, brings significant reform to Medicaid and elder care—but it doesn’t remove the need to plan. It gives you tools—but you still need to use them.
What’s in the Bill for End-of-Life Care
1. Federal Medicaid Expansion for Home & Community-Based Services (HCBS)
$180 billion over 10 years for home care alternatives to nursing homes
Higher wages and improved availability for caregivers
Waitlists for in-home care services will shorten significantly
What this means for you:
More seniors will be able to stay in their homes longer and avoid premature institutionalization.
2. Automatic Medicaid Eligibility for Terminally Ill Seniors
Terminally ill seniors with under $50,000 in assets (excluding home) are automatically eligible
Bypasses the 5-year lookback and spend-down process
What this means for you:
A major win for families facing sudden end-of-life diagnoses—no more estate liquidation to qualify for care.
3. National Long-Term Care Planning Requirement
Free planning session required for Medicaid and Medicare Advantage enrollees
Covers advance directives, living wills, and care navigation
What this means for you:
More people will finally have “the conversation”—about dying, about wishes, and about what matters most.
4. Expanded Asset Protections for Spouses and Survivors
Spousal asset allowance increased to $180,000
Homes under $1 million exempt from Medicaid estate recovery (if spouse or disabled child remains)
What this means for you:
Families can now pass down a home or nest egg without losing everything to Medicaid clawbacks.
5. Medicaid Reimbursement Boost for Palliative & Hospice Care
15% increase in Medicaid reimbursements for hospice/palliative care
Funding for home-based and mobile hospice teams
What this means for you:
Easier access to comfort-focused care at home, not just hospitals or institutions.
What Should You Do Now?
Start the conversation with your spouse, parents, or children.
Complete your advance directives: Living Will, DNR, Healthcare Proxy.
Explore Genera’s Legacy Planning tools to navigate Medicaid, long-term care options, and end-of-life costs.
Watch your state’s rollout: Some states may delay or deny OBBB provisions. We’ll help you track it.
Real Family Examples
The Wasted Inheritance
Betty and Don were married 50 years. When Don needed memory care, Betty had to spend down $150,000 to get him Medicaid-approved. He died three months later. Under the new bill, Don would’ve qualified immediately—and Betty could’ve kept their nest egg.
The Home That Stayed in the Family
Maria’s mother passed while receiving Medicaid. Before OBBB, their home would’ve been seized. Thanks to new spousal and disability protections, Maria and her brother now keep the home—and the memories.
Bottom Line: Plan While You Still Can
The One Big Beautiful Bill is a huge step forward—but it doesn’t replace planning. If you don’t take proactive steps, your family could still face the same nightmare so many others do: financial ruin, painful decision-making, and family division.
Let Genera help you make a plan before it’s too late.
